Wednesday, October 14, 2009

Rock Steady: Reflections from a Wednesday at Grady

Aretha Franklin a.k.a. "Re-Re" singing Rock Steady, 1971(check it out to get what I'm saying)

"Her stress test was negative, and she is still doing well without an oxygen requirement or any chest pain. If it's okay with you, Dr. M, I think we can let her go home," one of my interns said to me on rounds. "And I'll be sure to schedule her an appointment to follow up in the Primary Care Center in at least a week. I talked to her all about this, and she is comfortable with our plan." I was, too.

"Great!" I affirmed with a smile, "Do you know how she's going to get home?" I'm a pretty predictable attending. I like to know who a patient lives with, how they are getting home, but more importantly, even before we get to that point, I like to know for sure that the patient is not only aware of the plan but understands it, too.

"Her son is coming to get her. He lives with her and I talked to him this morning. I also spoke to her primary care doctor."

I gave my intern an exaggerated nod of approval as I marked the "discharge" box on my billing card. "Rock steady!" I stated for emphasis, still nodding.

Rock steady. It's one of my favorite sayings on rounds. It describes when all the parts are in place, and when we working as a well oiled machine. It's when we're all learning, showing empathy, and making folks feel better. It's what I think of when my team is doing a great job taking care of our patients, which they were. It's when folks are being cared for and treated with the respect they deserve. Rock steady.

"That was a song by 'The Whispers,' right Dr. Manning?" asked Adam, the fourth year student rotating me this month. "'Rock Steady' was."

I chuckled out loud and responded, "As a matter of fact, it was." I was impressed that a.) this twenty-something year old med student had any idea who "The Whispers" were, and b.) that he was clever enough to catch on to the fact that my use of the term "Rock Steady" was extracted from an R & B hit. He was almost spot on.

Almost. "Adam, you're right about that--and how you even knew about The Whispers is beyond me. Your knowledge of soul music will be reflected in your evaluation." Our team collectively laughed. "But you know what, y'all? Whenever I say, 'Rock Steady', I am thinking not of The Whispers, but actually of The Queen herself, Aretha Frankilin." The group was a little too quiet for me. What? Y'all aren't hip to Aretha singing 'Rock Steady?' Unacceptable. So, yep, you guessed it. I gave them my best "Re-Re" impression and broke out in song. Right there on the ward. (Hey, I saw it as a "teachable moment.")

"Rock Steady, Baby!That's what I feel now! Let's call this song exactly what it is! (What it is! What it is! What it is!)Step n' move your hips With a feelin' from side to side Sit yourself down in your car and take a ride!" (You have to lean back and do your one-handed steering wheel move on that part.)

They were cracking up laughing. (Probably as much at me as with me.) Something about that song makes a person feel so bold and alive that they could really care less who is laughing at or with them. Which was true--I didn't. The funny thing is. . . . .that song is on the "playlist" of my mental soundtrack-- especially when I'm on the Grady wards. Aretha Franklin's shrill, soulful voice on the track revs me up and boosts my confidence. Something about the beat, the horns, the whole laid back feel of the rhythm adds a little pep to my step and makes me want to throw my shoulders back and tackle anything that comes my way. Anything.

A patient cursing me out? Rock Steady, baby. Ten admissions? Rock Steady, baby. Twelve thousand things to do in only a limited number of hours? Rock Steady, baby. I'm with Aretha when she sings this one. Let's call this job exactly what it is.

It starts when I first pull into the Grady Piedmont Parking Garage. As soon as I step out of my car, the percussion instruments start shaking. By the time I begin walking through the lot, the bass guitar has kicked in and I'm right on step with the beat. I start swaying my hips ever so slightly from side to side while waiting for the elevator to carry me down from the deck towards the hospital. If no one joins me on the elevator, maybe I'll even bop my head and hum. . . . and sometimes, sing a line or two. What's amazing is that I can hear the entire song as if it were playing in Dolby Stereo on the most pristine system ever.

By the time I walk into Grady, Aretha has already belted out the first few bars and is doing her thang. Yep. Me and Re Re, jamming to the beat with a full set of brass backing us up--and me feeling amped for the day ahead. Horns! I want to do my best James Brown slide across the floor of the hallway but usually decide against it as not to frighten the onlookers. (I have done it at least two or three times, I admit.) Heeeeeeeeeeeyyy!!! (That's the good part.) That war cry always makes me want to shadow box in the corner for a minute or two before taking on the residents, students and patients. The backup singers are in my ear snapping their fingers and harmonizing, "What it is, What it is, What it is!" I shimmy my shoulders when no one is looking, tap my toes while writing notes, and thump my fingers on the chart box just a little bit. Rock Steady, baby.

****

I know it sounds kind of "Ally McBeal", but I think we all have our mental soundtracks at some time or another. (Well, at least I do.) But I especially do when caring for patients on the Grady wards. The music drives me forward, makes me think, and reminds me to be present. . . . . . really present.

I remember feeling particularly somber during my ward month in August 2005. Hurricane Katrina had annihilated New Orleans and her people, and I recall being glued to CNN between seeing my patients. I never forgot the desperate, crying, pleading victims. . .no, patients. . . . crowded outside of the New Orleans Convention Center waiting for assistance. Waiting and waiting. Hot and dehydrated. Lost. Scared. In shock. The women with babies--oh, those little babies--the elderly matriarchs and patriarchs, and their faces. The dazed children in frayed clothes. I prayed so hard for them back then. Especially at night. I knew they were afraid of the dark. . . . .my kids sure are.

Then, at some point during that month, the Red Cross began flying in patient after patient to be admitted to Grady. Suddenly, those nameless faces became real people as they joined the other patients on my census, and I recall being mesmerized and humbled by their stories. One lady who'd lost everything said to me, "The Lord is still in control, and I'm just gonna trust Him and keep on thankin' Him for all He's done for me." She had no idea where her family was, and was hundreds of miles away from all that she'd known for all of her seven decades of life. I couldn't believe that she still had this attitude in the face of such adversity.

At that point, I started hearing this song "I Will Find a Way" by Fred Hammond, a gospel singer, in my head over and over. My patient's words became a mantra, and that song. . . that song became a solemn soundtrack in my mind to remind me of my patients' struggles. Every time I heard it inside of me, I could feel my eyes stinging with tears-- I could see those faces waving on rooftops and wading through water. And what moved me about that track wasn't even so much about my faith. . . . it was more about hope. I interpreted that song as so hopeful for something better, and so thankful for the good that preceded the hard times. To this day, I am immediately transplanted to August 2005 whenever I hear that first few bars of the guitar strumming in that song . . . .

"Searching here and over there,for the things I've lost,I don't have them anymore. . .

But I will find a way to lift up my hands,and I will find a way to worship You, Lord,though my heart is low, I'll find a way,to give You praise. . .

Back then, it was Fred Hammond . . . .reminding me to always remember my patients' hardships and personal hells-- and to be careful to not complain too much. This month, it's me and good ol' Re Re, or if you don't know her like I do, Aretha Franklin. . . . Rockin' Steady.

My "playlist" changes often. . . .who knows what it will be on my next ward month?Either way, know this. . .if you see me around Grady with an extra skip in my step or even a reflective look in my eye, it's probably got as much to do with how I'm feeling that day as it does with what's playing on my mental iPod. And in an era of high tech everything, I like having my very own internal musical library linking me to emotions, experiences, and quite often, my Grady patients.

And to that I say, "Rock Steady, Baby." That's what I'm feelin' now. :)

Welcome to Atlanta.

"Becoming is better than being." - Carol Dweck

Who me? I'm just glad to be here.

Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)

What's the point?

"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."

~ James Baldwin (1924 - 1987)

"Do it for the story." ~ Antoinette Nguyen, MD, MPH

Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?